CONCLUSION: “Subendometrial microcysts” represent the most accurate ultrasound feature in the detection of adenomyosis in this study. The combination of three TVS features (“subendometrial microcysts”, “linear striation” and “myometrial cysts”) shows the highest accuracy, while “globular enlargement”, “heterogenous myometrium” and “asymmetry” show a lower accuracy and lead to a high rate of false-positive results. This article is protected by copyright. All rights reserved.
Ultrasound Obstet Gynecol. 2023 Mar 15. doi: 10.1002/uog.26197. Online ahead of print.
ABSTRACT
OBJECTIVE: Two-dimensional (2D) transvaginal ultrasound (TVS) is an accessible and cost-effective diagnostic tool in the detection of adenomyosis. Different ultrasound features related to adenomyosis have been described, but the predictive value of each ultrasound sign and their combination requires further investigation. We analyzed the accuracy of 2D-TVS and describe possible combinations of ultrasound signs with a high predictive value in the diagnosis of adenomyosis.
METHODS: This study has been conducted as a prospective multicenter trial including nine expert centers specialized in diagnosis and treatment of endometriosis. 202 patients scheduled for laparoscopic hysterectomy have been preoperatively examined using a standardized 2D-TVS examination including nine typical adenomyosis ultrasound features in order to predict or exclude the presence of adenomyosis. The ultrasound examination results have been compared to histology after hysterectomy. We analyzed the diagnostic reliability of nine ultrasound signs, combinations of ultrasound signs and the influence of simultaneous fibroids on the accuracy of results.
RESULTS: 202 patients were enrolled to this study. Histopathological examination revealed adenomyosis in 130 patients (64.4 %). The accuracy of prediction of adenomyosis by the present 2D-TVS examination was 0.634 (PPV 0.715, NPV 0.486, sensitivity 0.715, specificity 0.486). “Subendometrial microcysts” showed the highest accuracy of a single ultrasound feature (0.783), with a ppv of 0.836, a sensitivity of 0.911 and specificity of 0.231. The highest accuracy showed a combination of “subendometrial microcysts”, “myometrial linear striation” and “myometrial cysts” with an accuracy of 0.857.
CONCLUSION: “Subendometrial microcysts” represent the most accurate ultrasound feature in the detection of adenomyosis in this study. The combination of three TVS features (“subendometrial microcysts”, “linear striation” and “myometrial cysts”) shows the highest accuracy, while “globular enlargement”, “heterogenous myometrium” and “asymmetry” show a lower accuracy and lead to a high rate of false-positive results. This article is protected by copyright. All rights reserved.
PMID:36920431 | DOI:10.1002/uog.26197
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